Dysphagia: What's Behind Your Swallowing Difficulties?

Swallowing is a complex process that involves the coordinated action of at least 30 muscles and multiple nerves in the mouth, throat, and esophagus. When any part of this system is disrupted, it can lead to swallowing difficulties, also known as dysphagia.

More prevalent in older adults, dysphagia can prove to be a minor inconvenience for some while for others it can lead to severe complications and put their health and quality of life at risk.

Dysphagia can present a variety of symptoms, broadly categorized into two types: oropharyngeal and esophageal. The type of symptoms being experienced serve as clues to medical professionals about the potential cause of the condition.

Here’s how the symptoms of oropharyngeal and esophageal dysphagia differ:

Oropharyngeal Dysphagia:

Difficulty starting to swallow: This includes trouble moving food from the mouth to the throat.
Choking or coughing: Food or liquids might enter the airway instead of the esophagus, causing coughing or choking.
Nasal regurgitation: Liquids or food coming back up through the nose.
Gurgling voice: A wet-sounding voice after eating or drinking.
Recurrent pneumonia: Due to aspiration of food or liquids into the lungs.

Esophageal Dysphagia:

Feeling of food stuck in the throat or chest: A sensation that food is lodged somewhere in the esophagus.
Painful swallowing: Discomfort or pain when swallowing.
Regurgitation: Bringing food back up without nausea.
Heartburn: A burning sensation in the chest.
Unexplained weight loss: Difficulty in swallowing may lead to a reduced intake of food, resulting in weight loss.

With a clear understanding of the type of dysphagia you’re experiencing, your healthcare provider can begin to explore what’s specifically behind your condition.

COMMON CAUSES OF DYSPHAGIA

Oropharyngeal

Aging

Head and neck surgeries and injuries

Dementia

Stroke

Parkinson’s Disease

Amyotrophic Lateral Sclerosis (ALS)

Multiple Sclerosis (MS)

Muscular Dystrophy

Thyroid Enlargement: Often the result of an iodine deficiency or Grave’s Disease

Pharyngitis and Tonsillitis: Inflammation of the throat and tonsils most often due to infection

Oral Candidiasis (Thrush): Soreness in the mouth and throat resulting from a fungal infection in the mouth

Esophageal

Aging

Esophageal Stricture: A narrowing of the esophagus, often the result of acid reflux of gastroesophageal reflux disease (GERD)

Esophageal Rings and Webs: Thin layers of tissue that form in and partially block the esophagus. These can be congenital or develop later due to chronic acid exposure from GERD.

Esophageal Tumors: Benign or malignant growths in the esophagus. Risk factors include smoking, heavy alcohol use, and family history.

Diffuse Esophageal Spasm: Irregular spasm contractions of the esophagus brought on by damage to the nerves that coordinate the muscles of the esophagus

Scleroderma: Hardening and tightening of the skin and connective tissues that restricts the esophagus, resulting from an autoimmune disease

Eosinophilic Esophagitis: An allergic inflammatory condition often related to food allergies and environmental allergens

Understanding the type of dysphagia you are experiencing and the underlying cause is crucial for effective treatment and management.

Beyond assessing your symptoms, diagnosis often involves a clinical examination and imaging studies. Based on the findings, treatment may include:

Swallowing therapy: Exercises to strengthen the muscles involved in swallowing
Lifestyle changes: Modifying eating habits and using safe swallowing strategies
Dietary modifications: Changing the texture of foods and liquids to make swallowing easier and/or reducing acid intake.
Medications: To manage underlying conditions like infections or inflammation.
Surgery: In cases where structural abnormalities need to be corrected.
Dilation: Stretching narrowed areas of the esophagus.

If you or someone you know experiences persistent difficulty swallowing, contact your doctor. Addressing any issue early can significantly improve outcomes and help you return to living your life fully sooner.

Kate O'Neill, MS, CCC-SLP, is a speech-language pathologist at SVMC Outpatient Rehabilitation, part of Southwestern Vermont Medical Center.

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